Electrocardiogram and rhythm strip interpretation by final year medical students

The pre-registration house officers (PRHO) is often called upon to interpret electrocardiograms ECG. We invited final-year medical students who had successfully completed their written final examinations, to interpret three rhythm-strip tracings, and three 12-lead ECG tracings. The rhythm-strips were of ventricular fibrillation (VF), ventricular tachycardia (VT), and complete heart block. Of the three 12-lead ECG tracings, one was an inferior myocardial infarction (MI), one was atrial fibrillation (AF), and one showed no abnormality. Forty-six medical students attended. Of these, 50% had received no formal training in ECG interpretation, although 89% had tried to learn ECG interpretation from books. Only 9% felt confident in their interpretation of ECG tracings. Of the rhythm-strips, 100% correctly identified VF, 96% recognised VT, and 67% identified complete heart block. Of the 12-lead ECG tracings, 61 % recognised the MI, 54% recognised AF, and only 46% successfully identified the normal ECG as such. The group were significantly worse at 12-lead ECG interpretation compared to rhythm-strips (p<0.01). The members of the group who had received formal training in ECG interpretation were significantly better at interpreting both rhythm-strips and 12-lead ECG tracings (p<0.05). It would appear that formal ECG training as an undergraduate improves PRHO interpretation of ECG tracings, and the PRHO should not interpret 12-lead ECG tracings without consulting more senior medical staff.